Two lectures on lithotrity and the bi-lateral operation : delivered in London, Birmingham, Bath, and Bristol / by Edwin Lee ; from the London medical gazette.
- Lee, Edwin, -1870.
- Date:
- 1837
Licence: Public Domain Mark
Credit: Two lectures on lithotrity and the bi-lateral operation : delivered in London, Birmingham, Bath, and Bristol / by Edwin Lee ; from the London medical gazette. Source: Wellcome Collection.
Provider: This material has been provided by University of Bristol Library. The original may be consulted at University of Bristol Library.
12/18 (page 12)
![a high degree of irritation. The frag- ments are often only arrested for u short time, being expelled on the patient’s making water in a full stream ; but should this not be the case, they should, if pos- sible, be pushed back into the bladder with a full-sized sound. This, however, cannot always be done, and two or three instru- ments have been invented for the purpose of breaking them down ; though from the difficulty of their application the at- tempts would be very likely to fail in in- experienced hands, in which case it would be necessary to cut down upon, and ex- tract the foreign body through, the peri- neum. This operation has, I believe, only been required on two or three occasions, as the fragment can in most cases be pushed back, the portion of the urethra between it and the bladder being generally dilated by the accumulation of urine. This accident, then, is one of the principal obstacles to the success of lithotrity in some cases; but the consequence most to be apprehended is the occurrence of cys- titis, which is said to be more frequent after percussion, from the bladder being injured either bv the blows on the extre- mity of the instrument, or by the frag- ments being violently projected against its parietes at the moment the stone is broken. This last accident may also hap- pen when pressure is employed, if the stone be very hard. The liability to cystitis must also depend in great measure upon the size and nature of the stone, the con- stitution of the patient, the capacity of the bladder, or upon the pre-existence of a state of chronic irritation ; though this complaint is sometimes much relieved after two or three sittings of lithotrity. From whatever cause cystitis arise, it is a most unfortunate complication, fre- quently terminating in the death of the patient, either in consequence of the di- rect effects of the inflammation, or by in- ducing disease in the kidneys or other parts. Tt is not, however, of very frequent occurrence after lithotrity j and where, from peculiar circumstances, a predisposi- tion to it exists, the stone should be broken by pressure if possible, in pre- ference to percussion. The sittings should be short, and repeated only .when all irri- tation has subsided, the patient being kept in the intervals at rest, upon a bland diet, and recommended to drink freely of mu- cilaginous drinks. Another inconvenience to which litho- trity may give rise is the pinching or la- ceration of the mucous membrane of the bladder by the instruments, during the operation. This is, of course, an unplea- sant accident, though it seldom happens in the living body, where the bladder can be kept properly distended with fluid ; nor would it probably be attended with the evil consequences which some persons a]u prehend. It is more likely to happen with instruments for perforation than with those for percussion and crushing, as the hooks by which the branches terminate would be more apt to catch the membrane than the teeth of the branches of other instruments; hut on the dead bladder, in consequence of its flaccid state, this acci. dent notnnfrcquently occurs; and even in the living body, where there is diliiculty in taking up small fragments, and where the mucous membrane is thickened, or its surface irregular, it would be very liable to be caught. This, however, would be indicated by the increased pain, which would prevent the operator from perse- vering in the attempt. Having thus glanced at some of the principal inconveniences attendant upon lithotrity, I must not omit to allude, on the other hand, to some of those which lithotomy entails. The operation is one of the most painful and dangerous in surgery; and the difficulty of perform- ing it is sometimes very great. It is often counterindicated by diseased states of the urinary organs, or of other viscera; and when performed under these circumstances, it offers very small chances of success; while, on the other hand, lithotrity might be practised with great prospect of advan- tage. In the lateral operation the catting instrument, especially the gorget, may not at first enter the bladder, or the incision at the neck of this viscus may not be suffi- ciently large to admit of the extraction of the stone without the employmentof much force, and consequent bruising or lacera- tion of the parts. On the other hand, if the incision be too large, it may give rise to urinary infiltration of the cellular tex- ture—the rectum may be cut—haemor- rhage may take place to a dangerous ex- tent, either from the division of arterial brandies, or of the enlarged veins sur- rounding the neck of the bladder in old persons. Nervous symptoms of an alarm- ing character, which so frequently super- vene on serious operations, may endanger the patient's life, as may also fever, in- flammation of the bladder, of the . perito- neum, or. of other viscera, should these unfortunate complications arise. These are the principal inconveniences and dan- gers to which lithotomy may give rise; though it is but right to add, they are not so likely to occur in young persons. From most of these consequences lithotrity, while presenting its peculiar disadvan- tages, is exempt. The remarks that have been made re- speetiug both operations refer more espe- cially to the male sex, in whom operations for the stone are, for obvious reasons, so](https://iiif.wellcomecollection.org/image/b21438638_0014.jp2/full/800%2C/0/default.jpg)
